DESCRIPTION (TAKEN FROM APPLICANT): The University at Albany, School of Public Health, in cooperation with Albany Medical College proposes a longitudinal, qualitative case study intended to explore how residents are socialized around the issues of mistakes and how the best practices associated with a "learning-type atmosphere" manifest themselves among faculty and residents within two separate training environments. These best practices refer to specific ways of thinking, interacting, and behaving among these two groups that result generally in heightened systems thinking and a greater propensity towards teamwork around patient safety, development and promotion of a shared vision with respect to the definition and processing of mistakes, and a personal approach to coping with and reducing mistakes that is self- reflective, empathetic, and learning-oriented. The specific aims of the study are five-fold: (a) describe and compare how residents are socialized around the issue of medical mistakes within a contemporary physician-training environment; (b) identify existing points within the training culture that already contain elements of a "learning organization" in relation to how mistakes are defined and processed by individuals; (c) compare across two clinical specialties and two leadership dyads of the residency training hierarchy opportunities and barriers for incorporating specific activities associated with learning cultures around the treatment of mistakes; (d) explore potential gender and race/ethnicity differences in how residents respond to and learn from mistakes and near miss situations; and (e) begin drafting a model "cultural template" that can be validated in other residency settings for the purpose of being used by residency programs nationally to assess and enhance their environments with respect to residency socialization around mistakes. Data collection will focus on two clinical specialties, i.e., surgery and medicine. It will consist of extended fieldwork including observation of interactions between residents and attending faculty in the course of their daily clinical work, examining how actual mistakes play out within the residency environment, as well as one-on-one interviews and focus groups with these same individuals. Meeting these aims inform our understanding of how residency training environments can socialize young physicians to think and act around mistakes in a way consistent with what the Institute of Medicine Report and others call for in discussing the need for "learning-type atmospheres."